The Papua New Guinea (PNG) Department of Health introduced a
'test and treat' malaria case management protocol in 2011. This
study assesses health worker compliance with the test and treat
protocol on a wide range of measures, examines self-reported
barriers to health worker compliance as well as health worker
attitudes towards the test and treat protocol. Data were
collected by cross-sectional survey conducted in randomly
selected primary health care facilities in 2012 and repeated in
2014. The combined survey data included passive observation of
current or recently febrile patients (N = 771) and interviewer
administered questionnaires completed with health workers (N =
265). Across the two surveys, 77.6% of patients were tested for
malaria infection by rapid diagnostic test (RDT) or microscopy,
65.6% of confirmed malaria cases were prescribed the correct
antimalarials and 15.3% of febrile patients who tested negative
for malaria infection were incorrectly prescribed an
antimalarial. Overall compliance with a strictly defined test
and treat protocol was 62.8%. A reluctance to test
current/recently febrile patients for malaria infection by RDT
or microscopy in the absence of acute malaria symptoms,
reserving recommended antimalarials for confirmed malaria cases
only and choosing to clinically diagnose a malaria infection,
despite a negative RDT result were the most frequently reported
barriers to protocol compliance. Attitudinal support for the
test and treat protocol, as assessed by a nine-item measure,
improved across time. In conclusion, health worker compliance
with the full test and treat malaria protocol requires
improvement in PNG and additional health worker support will
likely be required to achieve this. The broader evidence base
would suggest any such support should be delivered over a longer
period of time, be multi-dimensional and multi-modal.